One rationale for expanding health care coverage is that it will reduce the use of emergency rooms for non-emergency care, improving care coordination and reducing costs, since the ER is an expensive site of care. Early experience in Massachusetts suggested that ER use actually increased following the coverage expansion. A new article in the Archives of Internal Medicine examines changes in insurance coverage and ER use more globally. (Archives Article) As the authors note, ERs are already overcrowded so understanding the impacts of insurance changes is important. They looked both at subpopulations which gained coverage and those which lost it. The research used national survey data from 2004 to 2009, which covered about 160,000 adults.
The researchers compared continuously insured, newly insured, continuously uninsured and newly insured adults in regard to emergency room use. The analysis was adjusted for demographic, socioeconomic and health status factors. Overall, 83% of respondents were insured and 17% uninsured. In total, about 13% reported one ER visit in the last twelve months, 5.4% reported 2 or 3 visits and 2% had 4 or more visits. As might be expected, Medicaid enrollees had the highest rates of ER use and people with private insurance the lowest rates. Newly insured adults had 37% higher ER use than did continuously insured ones, a particularly strong effect for Medicaid enrollees. Similarly, newly uninsured adults had 39% higher ER use than did continuously uninsured persons, with greater use reported in the first six months after losing coverage. The results show that either loss or gain of insurance is strongly associated with ER use, suggesting that implementation of the reform law will lead to more ER use, at least initially.